Vertebral Augmentation Versus Conservative Therapy for Emergently Admitted Vertebral Compression Deformities: An Economic Analysis

Background: Vertebral augmentation (VA) performed on inpatients with painful osteoporoticvertebral compression fractures (VCFs) has been shown to facilitate discharge, decreaseanalgesic requirements, and improve pain.Objective: The purpose of our study was to compare the overall cost, length of stay, andreadmission data for patients hospitalized with painful osteoporotic VCFs, treated eithermedically or with inpatient VA.Setting: A single academic medical center.Study Design: Economic analysisMethods: Patients admitted with VCF over a 30-month period were identified using ICD-9codes. The total length of stay, hospitalization costs, average daily cost, and 30-day readmissionrates were compared between those who underwent VA and those managed nonoperatively.A subgroup analysis was performed with an age matched group of controls as well. Two-tailedt-tests were used for statistical significance.Results: Thirty-nine inpatients underwent VA; 61 levels were augmented. Their averageage was 81.7 years. There were 209 patients who were treated nonoperatively for VCF. Theiraverage age was 72.7 years, a significant age difference from the VA group (P < 0.01). TheVA patients’ average length of stay was 13.8 days, compared to 8.1 days in the medicallymanaged group (P < 0.01). Average total costs were $26,074 in the VA group and $15,507 inthe medically managed group (P < 0.01). The daily costs of admission were $2,040 in the VAgroup and $2,069 in the medically managed group (P = 0.85). The readmission rates related toVCF were 0% in the VA group; 5.2% in the medically managed group; and 7.7% in the agematched control group. Of those who underwent VA, 43% experienced delays in care relatedto anticoagulation or medical comorbidities.Limitations: The study is retrospective and uses billing data as a marker for total cost of care,The study does not account for cost differences between vertebroplasty and kyphoplasty.Conclusion: Inpatient VA can be cost effective as demonstrated by the same daily costbetween the VA and medically managed groups. Early identification and consultation canfacilitate VA and rapid discharge. Anticoagulation issues and medical comorbidities can delayVA and lengthen hospital stays. Hospital admitted patients with painful osteoporotic VCF whoare managed conservatively and discharged are at risk for readmission.Key words: vertebral augmentation, osteoporotic vertebral compression fracture,vertebroplasty, kyphoplasty